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NPI Code Detail

MEDICARE: MIDWEST DIVISION - LRHC LLC

MEDICARE: MIDWEST DIVISION - LRHC LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR1300XRural Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003872185
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDWEST DIVISION - LRHC LLC
Provider Business Mailing Address
First Line : 316 WEST 40 HWY
Second Line :
City : ODESSA
State : MO
Zip : 64076-9612
Country : US
Telephone Number : 816-633-5774
Fax Number : 816-633-5936
Provider Business Practice Location Address
First Line : 316 WEST 40 HWY
Second Line :
City : ODESSA
State : MO
Zip : 64076-9612
Country : US
Telephone Number : 816-633-5774
Fax Number : 816-633-5936
Authorized Official
Title or Position : CEO LRHC
Name : DARREL BOX
Credential :
Telephone Number : 660-259-6852
Provider Enumeration Date : 04/26/2006
Last Update Date : 01/06/2022

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Directions to “MIDWEST DIVISION - LRHC LLC ” Practice Location

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